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HomeMy WebLinkAbout020-1376-73-000Wisconsin Department of Con ~nerce PRIVATE SEWAGE SYSTEM Safety and Building Division ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide ma'.' be used for secondary purposes [Privacy Law, s.15.04 {1){m)]. Permit Holder's Name: City Village X Township Sengbusch, Carroll Hudson Townshil CST BM Elev: Insp. BM Elev: ~r~, o ~ ~e0, a' TANK INFORMATION TYPE .MANUFACTURER CAPACITY Septic lv E>o1L. 2, O Dosing Aeration Holding TANK SETBACK INFORMATION" TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~~,~ ~ ~ ~~ ( ~_. Dosing Aeration Holding DI 11191D/CID4.1/lAl Itil Cf1D1-A ATI(lAl Ft SOIL ABSORPTION SYSTEM /t 1.1. >>/~ti..~..~ C.~F~Wt,~'~ ~.. ELEVATION DATA County: St. CfOIX Sanitary Permit No: 405065 0 State Plan ID No: Parcel Tax No: 020-1376-73-000 1`l~Zy. 9 .~,~ STArT40N BS HI FS ELEV. enchmark~ ~ Z•a t o2.0 t .p Alt. BM ~ Y Bldg. Se r ~• .s~' SUHt Inlet Q~~3 p 93• ~t SUHt Outlet q,D ~3 ~ ~ • Dt Inlet Dt bottom Header/Man. Dist. Pipe ~•~ RZ • Bot. System l~~$ R~•oz.~ Final Grade .-.. ~ ~ r D N St Cover RENC Width Length ~ No. Of ;Tenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME IONS ~~ m b'r G. SETBACK INFORMATION SYSTEM TO P/L BL G WELL LAKE/STREAM LEACHING CHAMBER OR Ma of cturer: ~ 1r Q(/ Type Of System: Co~~ . ~ ~ ~r 1 8s L UNIT ~ y M I~lumber: DISTRIBUTION SYSTEM ~, ea /Manifold Distribution a Hole Size x Hole Spacing Vent to Air Intake ~O h pipe(s) ~.. ~ ~ Length t Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 'L; Yes _~?~ No `~ Yes j~l No COMMENTS: {Include code discrepencies, persons present, etc.) Inspection #,1~v~*X~/ ~~Z" Inspection #2: Location: 945 Fraser Lane Hudsorn,_WI 5j~440.1~6~(SW 1/4 NW 1/414 T29N R''1++9~~W) Swee ~G`r'ass~Fpa~r~r~t .Lot 73 Parcel No: 14.26.19-.~2y3~34 1.) Alt BM Description = ~pA~ ° """^~"'~" ~~ ~~ Z~OC.~,~~~ rT°~R„~i~-~~ ~ (V ~>~ ~ T' 2.) Bldg sewer length = ti 6~~ ~_ (~_ ~ ~~Jt _ ~ ~ N~~ .(... .,a~- - amount of cover = QM~Ws a~u~.w IY~ q ~ C _1 ~ - - ~ -- _-- __ _ _ ---- ---_ _ __ __ - - --- Use otherls de for addition I formation. No• _ ~: _ ~ _ _ _ - ~ I ~ T- ~ - - - -~ _ - SBD-6710 (R.3/97) ~ ~~ l Date -~ ~- sepctor's Signature Cert. No. -~~~~~:. Q Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 CO1~' ` isconsin ~~~, ~ 53707 - 7162 Site Address ~ De artment of Commerce S Z ©/ S ~ -S ~ ~ Sanitary Permit Application ~~' Permit Number ` In accord with Comm 83.21. Wis. Adm. Code, personal information you provide /~j/~ L,/ y7 ~ ~ ^ Check if Revision / v `'' (/ ((/ ma be used for ses 1?riv Law, s15. 1 m I. Application Information - Ptettse Print All Information RECEIVED Plan I.D. Number _~ '- ~ Property Owner's Natne ~ . (~ • ~ 3 l Number lT `~ MAY 0 6 20 Do?D -/3-7,6 - 73 -~ d Property Owner's Mailing Address Property Location ~ ~ ~ ST. CROIX COUNTY ~ ~~ ZONING " rJ '~ ~: S / N, R >~ ~ City, tau Zip Code Phone Num r Lot Nu~ r Bloc N ben R Subdivision Name 6SAQ~-AG+mbeF-- J G'/ (v II. Type of BuOtiing (check all that apply) / ~~.~ ^City ~ v 1 or 2 Family Dwelling -Number of Bedrooms " ^Village ^ public/Cotrrtnercial -Describe Use Township ~' ^ Stau ~~ Nearest Road 1 III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 ~ New 2 ^ Replatement Sysum 3 ^ Replacement of 6 ^ P.ddition to For County use stem Tank Onl Eris ' sum Permit Number Dau Issued B. ^ Check if Sanitary Permit Previously Issued FV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) ~ 7~~/C~f~' 3 ~X ~ ~ - ~ ~, Non -Pressurized In-Ground / 21^ Mound 47 ^ Said Filur 50 ^ Constructed Wetland ~~Z 44 , ~ ^ prey ~~}round 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Trea nt ni 49 ^ Recirculating 3U ^ Other V. D' tment Area Informati Design Flow (gpd) Dispersal Atea on: ~.r'~ ' , Dispersal Area it Application ' Percolation Rau System Elevation Final Grade Required Proposed Itate(Ga1s./Days/Sq.Ft.) (Min./Inch) Eeevation ` / o VI. Tank Inf CaPacitY in .Tonal Number Manufacturer Prefab Coacreu Site Constructed Steel Fiber Glass Plastic Gallons Gallons of Tanks New Existing Tanks Tanks k T i an ng Septic or Hold _.,, C> Dosing Chamlxr ~ VII. R risibility Statement- I, the tmdersigned, a responsibility for hsstallatIon of the POWTS shown on the attached plans. Pl r' N ) ~ Plum is Si MPRvIPRS Number Busirtess Phone Number •~ r S ~ / Plumber s Address (Street, City, Stau, Zip e) ~~. R~/~ S ~~~ VIII, tmt /De artment Use Onl Sanitary Permit Fee (includes Groundwaur Dau Issued Is Age Signature Stamps) PProved ^ Disapproved Surchar a Fee) ~_--- 5 ^ Owner Given Initial Adverse ~ ~ ~ / Deuratination IX. Conditions of ApprovaUReasons for Disapproval Q ,S~~f~t'.rc_S ~Erl" GcJ~-~L-- /NS"7A'~~' f i1aPo'~ ~b ~~.o> l~c,~ ~v~- S./~5 • v~~'zs' snatr~~ cane: ~ ~?0•.1 war, n/c~ `~ a~>..SO' ~-, s,.~•S ~ .! zs'-' !-~Za~t TA~tK M ~ ~ . 1b,t.i'07't~~vA'~~'" o,e Autt:.d e~ R~G~m1i A~~ (.Sa,e/N~ 3 ,S~ orr~ ~ cJ~1 REJ ~s B To ~_ ~ ~~ P~ P T A[faW Wmt/1QC Piaui lw ,ac a.wu~) ~7/ a.n arc .~....... .... r~._. SBD-6398 (R. 05/01) _ _ - ~~~ ~ ~~ _ ~~ 1 l ~~ `~ 4 ~ ~~ •~ ~ ~ ~ jC t'" -3 , ' "~ ~ ~ ~ . ,ti ~, ,i ~ ~ \~~ p Ca ~ 9r_x O S ~a ~~ M ~ :~ ~~~. ~~~~ ~~' ~; ~ _ ._ ____ ~` ~ _. ___ ~i~~ ~ -- - ~J ~~ `~ ~_ ~ ~ . ~~ ~ o '~ ~ ~ ~ 3 ~ ~ ~ ~ ~ 4 a ~1 ~ ~ ~ ~_ ~ 4 ~- ~' ,~ ~ ~~ ~ ~ 4 0 ~~~ ~ ~ i ~ ~ ~~ ~ ~ ~~ ~ ~`~ ~ ~ ~ ~ ~~~ ~~~~ ~ G ~ ~, `~ ~ 1 ; ~' ~ i ~ ~ ~ ~ ~'II'r w~SZSVRrT~ SUPPLY INC. ~_ ~ -~ ~, -d. ~ ~ /~3 ~,$ , ~ ,~ loo ,~ ;.. '~ - s3 /'X S'~Q~: r f i_ MUSTEE Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings ~----~-~~---_, Page ~ of Bury,`u of Integrated services ' in accordance with Com3,d9} ~~. Adm. Code ~~ "~~. County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Pl~n•must ~, include, but not limited to: vertical and horizontal reference point (BM), dire~tiorr and ~ j•' t `~ ~ ~ f percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel LD. # _ . ; . ,, ~. _ ...„,« APPLICANT INFORMATION -Please print all information. ~ f3 iewe b" Date Personal information you provide may be used for secondary purposes (Privacy Law s. 15.04 (1) (m))., `' '~ ,. G~~u~L..IV C,i~y~- ~~ 3 O~. ,:(..UE" Property Owner Property Location Govt. Lot ~~~~ ~ i 4' Mw 1/4,S /~/ TZC, ,N,R /g' E (or)b Property Owner's Mailing Address Lot # ubd. Name or CSM# t 35 A~-Eul~e r• ~ e-~ C~ City State Zip Code Phone Number ^ City ^ Village ®Town Nearest Road New Construction Use: ~ Residential /Number of bedrooms Addition to existing building Replacement ^ Public or commercial -Describe: Code derived daily flow ~ ~U _ gpd Recommended design loading rate ` ~ bed, gpd/fl2_ p~trench, gpd/ft2 Absorption area required ~S7 bed, ft2 7 S~ trench, ft2 % Maximum design loading rate bed, gpd/ft2_~_trench, gpd/ft2 Recommended infiltration surface elevation(s) ~ ~ Z y ~/ ft (as referred to site plan benchmark) Additional design/site considerations ~G7` q ~' 2 `~ /~/ /-~~~~~ SJ~'~ ~(/ ->~- ft Parent material ~ U ~ ~ ~ S Lt Flood plain elevation, if applicable S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank u unsuitable for system [~ S ^ u ~ s ^ u ,®s ^ u ~ s ^ u ^ s ~ u ^ s ~ u Boring # Ground elev. /~iun. Depth to limiting factor ~_in. Boring # ~~ Z ~Inr Ground ~ elev. ~oo.z~~- ft. Depth to limiting factor Il<i r., cnu nFSCRtaTInN REPORT Horizon Depth Dominant Color Mottles Structure B d t R GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence oun ary s oo 8 ,Trench i d-~ ! ~ -- ~' 1 ~ m ~ S v ~ ~ ~ . ~ ~ ~ , t. 1~~ Remarks: I b~13 v --_ ~ i k- -fir 1 • s ; - ~ G/ ' q~N , Ramarkc• ;.ST Name (Please Print) Signature Telephone No. Address Date CST Number z i / 3 ~a f"`' -~. ~ ~ sc Gr / S'Ya~ s- ~/ -~i'--C~c 2S3 3 6 ~ PROPERTY OWNER S ~ ~~ SOIL DESCRIPTION REPORT PARCEL I.D.# DZ D' 13 ~ ~ -7 3 - Boring # 3 Ground elev. Depth to limiting factor J[~in. Boring # ~~ Ground elev. lod. L4 ft. Depth to limiting factor f ~ in. Boring # S Ground elev. too. zit tt. Depth to limiting fact r ~in. Boring # Ground elev. ft. Page ~ of Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry ,Trench Zs ~ 3 zf __ ~ G5 - °' - Co ~ 11 y~ ~--~- tYIS O c S ~- -1 ~~~/ ' (B ' Remarks: a-13 2 .,-- ~' I ~ ~~ l v~ 3 yg-1 ~ ~f ~ ---- '~'~ m ~S ''~ - . $ l • ~l ~ ~(c ~ ~ , ~O ~ Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ,Trench t o- 3 l Z r- ~. m~i- c - 1 v~ ~ ~ ~ 3 ~-1 ~ Ala ~ ~ 5 ~- ~ , . ~, 6v .f--s 1 Z' hi. ~nsh.a... , , ~- '` _ ~- o -s ~ - s ; Depth to limiting ' factor in. Remarks: Remarks: SBD-8330 (R.9/9$) a `~ ~ s PAGE ?j OF~ NAME ~ -Fc~c~-t~ LOT#~~ LEGAL DESCRIPTIONSW'/4r//~/4,S IK TZ4 ,N,R/4 E (or)~V~ SCALE: I"= ~(~ BM 1 ELEVATION ~~n . C~ BM 1 DESCRIPTION(rro~hdt C.we.t ~f ba~~ nL ~atJ1~/F BM 2 ELEVATION 1 C~ U • O BM 2 DESCRIPTION~,,,,,,,,~t («,~.~ c ~ b4SE .. C /a+-h 6~/ 41a.c~ 2 G J SYSTEM ELEVATION ~I S• ALTERNATE ELEVATION q S• 2 ~I CONTOUR ELEVATION d/ (Q _ -~ . x t ~G Z'` ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer CG/moo // 5~e.~r ~u ~c~ Mailing Address S~'~~e /< J~ OS'c ea lc. , _L,I~'.~YdZ d Property Address ~ s ' ` (Verificati/on required from Planning Department for new construction) ~~ City/State _}~ CJ~Q~^'~ (~.Z Parcel Identification Number a~ ' ~37~ ' ~3-v~2~ LEGAL DESCRIPTION Property Location SW '/,, ~ '/4, Sec. l ~/ , T ~~o N-R~W, Town of ~~...cQs'or1 Subdivision _ S(.,t ee.~Q r''c•s~ ,Lot # ~ 3 Certified Surve Ma # ~ Y P ,Volume ,Page # Warranty Deed # ~~~~~9 ,Volume ~~_,,,~, Page # 2-~ Z Spec house O yes ~ no Lot lines identifiable ~ yes O no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Ptoper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I } the on-site wastewaterdisposalsyscem is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/wc, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 dpays of the three year expiration date. ~~ ~ ~}',~ SIGNATURE OF APPL ,ANT DATE 9WNER CERTIFICATION I (we) certify that all statements on this farm are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Cars ~. ~ / C6 / o ~ SIGNATURE OF APPLICA T DATE ****"`* Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. *..*** ** Include with this application: a stamped warranty decd from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL 13t MANAGEMENT PLAN Page ~ of FILE INFORMATION ~ SYSTEM SPECIFICATIONS Owner 4g,~'~i?~ / .~tiG ~~~s~ Permit # ~OS'O~ ~.,-- DESIGN PARAMETERS Number of Bedrooms O NA, Number of Commercial Units NA Estimated flow (average) gal/day Design flow (peak), (Estimated x 1.5) gal/day Soil Application Rate gal/day/ftz Influent/Effluent Quality Monthly average* Fats, Oil 8t Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (BODs) <_220 mg/L Total Suspended Solids (TSS) _<150 mg/L Pretreated Effluent Quality ' ^ NA Monthly average** Biochemical Oxygen Demand (BODs) <_30 mg/L Total Suspended Solids (TSS) s30 mg/L Fecal Coliform (geometric mean) <_ ] 0' cfu/ l OOmI Maximum Effluent Particle Size ~ inch diameter Septic Tank Capacity al ^ NA Septic Tank Manufacturer ~~~ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ~ ^ NA Pump Tank Capacity gal ~.NA Pump Tank Manufacturer 1~ NA Pump Manufacturer 1~ NA Pump Model .~' NA Pretreatment Unit J~' NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) ;~ In-ground (gravity) ^ In-ground (pressurize d) ^ At-grade ^ Mound ^ Drip-line ^ Other: * Values typical for domestic (non-commercial) wastewater and septic tank efFluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDI]LE Service Event Service Frequency Inspect condition of tank(s) At least once every ^ months year(s) (Maximum 3 yrs.) Pump out contenu of tank(s) When combined sludge and scum equals one-third {fs) of tank volume Inspect dispersal cell(s) At least once every ~ ^ months ~ year(s) (Maximum 3 yrs.) can effluent (liter /V ll /~ (~- At least once every ^ months `year(s) Inspect pump, pump controls St:alarm At least once every ^ months ^ year(s) ~ NA Flush laterals and pressure test At least once every ^ months ^ year(s) ,~1 NA Other: At least once every ^ months ^ year(s) ~ NA other: At least once every ^ months ^ year(s) NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually Inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Ys) or more of the tank volume, the entire contenu of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement componenu, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the focal regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new coruwction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents ~r ,t. , ..nU{~1 r~~nnvo~ w 7 cP11r~OP cP1-Vt01114 0t1PC: tAf• Dl'i(1I- t0 11~P, Page ~ of System start up shalt not occur when soil conditions are frozen at the inMtrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the exceu wastewater will be discharged to the dispersal cell{s) in one large dose, overloading the cell{s) and mry result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tarok. r'edttaoved by a Sepage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or P04VTS M~Intalner to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over arks and dispersal ceils~ Ao not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil ahsorpt3pn area. Reduction or elimination of the foitowing from the wastewater stream may improve the performance and prolong the life of the l'OWTS: antibiotics; baby wipes; cigarette butts; condoms; cottap ~wa~~ degreasers; dental floss; drapers; dtsinfectanu; fat; foundation drain (sump pump} water; fruit and vegetable peelings; ~a~oltne; grease; herbicides; moat scraps; medications; oiF, painting t;roducts: pesticides: sanitary napkins; tampons; and water. sooner brine: ARANDONEMENT When the POWTS fails and/or is permanently aken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch: Comm 83:33, Wisconsin Administrativ+a Code: • All piping to tanks and pits shall be disconnected and the' abaridgned pipe openings sealed. • The contents of alt tanks and pits shall be removed and prcaperiy disposed of by a SepUge Servicing Operator. • After pumping, all tapirs and pits shall be excavated: and removed or their covers removed and the void space tilled with soft, gravel or another !Wert solid material. CONTINGENCY PLAN !f the POWTS fails and cannot be repaired the following measures have'k~een, or must be aken, to provide a code compliant replacement system: A suiable replacement area has barn evaluated and may be utilized for the- location of a replacement soil absorption system. The reptacement area should be protected front°diswrbance and compaction and should not be infringed upon by required setbacks from existing and proposed structdre, Vv'itn4s-and wells. Fatiure to protect the replacement area will result in the need for a new soil and site evaluation:w establish a salable replacement area. Replacement systems must comply with the rules In effect at that time. O A suitable replacement area is not availabte due to sretbaClt.and/or snll iimitattons. Barring advances in POWTS technology a hotdtng tank may be lnstaUed as a last resort to replace<khe failed POWTS. p The site has not been evaluated to identify a s~ltable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a sultabte replacehent area. If no replacement area is available a holding tank may be installed as a last resort W replace the failed POWTS, O Mound and at•grade soli absorption sysums may bt recortswcted to place fallowing removal of the biomat at the infiltrative surface. Reconstructions of such systems musi,cotnal~ with the rules In effect at that time. < <WNItNiNG> > S>rIP71C, ptIMP AND OTHER TREATMENT TANKS MAY GONtC~IN'4ETHAL GAST>ES AND/OR INSUFFICIENT OXYGEN. DC NaT ENTER A S1EPT[C, PUMP OR OTHIEI! TRIATMENT TANK UNDER ANY CIRCItMSTANCES. ©EATH MAY RESULi". RESCUE t'I`F A PERSON FRt'3M Ti~E INTERIOR OF A TANK MAY BE DIFFiCLILT ®R IMPE1t~1Mt1 F. ADDiTIONAL COMMENTS POWTS INSTA4LF~C ~ ~, ~~ Name ~ ~ - Phone _ ~ SEPTAGIE SERVICING OPg.RATOR PUMPER) Name _ Phone ~PO'iNTS MAINTAINER ;Name Phone II„OCA! RECaUL,ATORY AUTHORITY `~Y ~"~ ~, ~'~hone S = -' - ~ o , f~ STATE BAR OFF W1SC0 8 [ $ FORM 2 - 299 WARRANTY DEED Document Number ~. This Deed, made between uT_~ununs emnrrm .a z ;Pi13~' B. S'£98r~~ _ _-____ _ _ Grantor, '. and (`ARRn _- _ __ _ Crantce, Gra a valuable consideration, conveys and warrants to Grantee the following de ed ea cafe $t:-.~=''6~~G County, State of Wisconsin: Lot 73, P1 t of Sweet Grass Farm, Town of Hudson, St Croix County, Wisconsin. 677939 KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO., MI RECEIYED FOR kECORD 05-02-2001 2:45 Ph I:ARitIdPiTY L'EED E:cErF' a kEC FEE: 11.00 TRANS FEE: 1b7.70 COPY FEE: CERT COPY FEE: PAGES: 1 , , t:,, , Name and Return Address Edina Realty Title 400 S. 2nd St., #115 Hudson, Wl 54016 ~~~3~~ 020-1376-73-000 Parcel Idenlitication Number (PIN) This 15 nOtitomestead property (is) (is not) Exceptlonstowarrancies: easements, restrictions, rights-of-way and covenants of record. gated this day of Aznr i i ~ n n ~ ~t 19, dt ]J r(\\OU..~I (SEAL) _ (SEAL) Ri h>rd O Stout T .+ot n crr,,,+ __- AUTHENTICATION Stgnature(s) (SEAL) authenticated this day of , ACKNOWLEDGMENT (SEAL) State of Wisconsin, ss. St. CTOlx Co`Jn . Personally came before me this ` ' day of __ggri 1 , 2.QQ~•-_, the above named Richard 0 Stout and Janet P Stout ____ TITLE: MEMBER STATE BAR OF WISCONSIN - -- tO me known [o be tl~l~tk6R•sT-: --• :L~'JZo{~jecuted the foregoing ([f not, authorlted by §706.06. Wls. Scats.) instrument and~'T~pTi{d®(th~~`pNSIN KERNON J. BAST THIS INSTRUMENT WAS DRAFTED BY _- - _ - Janet P. Stout .. ~ 353 A[.ratnkee Tr ~ - -- - Hl1dSOri, WI 5401 6 Notary P lie. State of Wise si My co mission is perman (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not -~ • ---~~ ~ ~) necessary) .. _.. ... _.. Namez of persons signing In any capacity must he typed or printed below [heir signature. STATE BAR OF WISCONSIN Wiswnsm legal Bunk Co.. inc. WARRANTY DEED FORM No. 2 - 1998 nnnwaukee, wis. N89'48'60'E 1168.0'2 ,• Q~ LOT 77 R ~ 2.7a A~CRE8 ~ 115582 SQ FT , i , MIN BUILDING ELEV. s030.0 - 699.04' N80.48'a0'E 11 aa.08' MIN BUILDING ELEV.. 031.0 ~ $ LOT 76 Q 2.7a ACREB ~t 1 f ~9 8C FT 800.00' . N69'48'a0'E 116x.14' 9 4 • H.W.L. •530. 0 ~` LOT 75 • ' / MIN BUILDING 2'~ ~'R~ • • 114474 80 FT MIN BUILDING ~ ELEV. = 53t.0 _ . ` . ~ . ELEV. _ 93o.a MIN BUILDING ELEV. =530.6 W A ~_ MIN BUILDING :LEV. = 93o.a Ne9'aa'ao~E I ~, z.1 a i • /. ara.7x , o9o.5r . ~ / MIN BUILDING • . ELEV. =931.0 _ . ~ ..._. ~ LOT 74 . • ~~ ~ 2.33 ACREB . • ~ I tiN ,~~ 101289 8Q FT H.W.L. _ ~ !'~ 930.0 ~ '_.~ / !h . • / 'YA 489.18' ~ ,~,B.~Q' ~. - T~ MIN BUILDINt~A j ~~~ .: LO 73 ELEV. •031.0 ~ , ~ ~'~' 2.Oa AC Es . ~ W 89347 sa r ~ N.W.L. =930.0 ~ 4aa.1 a / ~1a 1 ~ MIN BUILDING